Survival rate and associated factors of unplanned hemodialysis initiation among end stage kidney disease patients

Abstract

In dialysis patients, the mortality rate was proved to be associated with different types of vascular access. Nonelective initiation of hemodialysis was associated with poor survival. The aim of this study was to examine the survival rate and associated risk factors for death of different type of hemodialysis initiation between unplanned and planned hemodialysis in Bhumibol Adulyadej Hospital, Bangkok, Thailand

               We performed a retrospective cohort study of all patients with chronic kidney disease (CKD) who underwent initiation for hemodialysis in Bhumibol Adulyadej Hospital between January 2009 and December 2020. Patients were classified according to how they started hemodialysis. Unplanned hemodialysis was defined as starting with a hemodialysis catheter. Planned hemodialysis was defined as starting hemodialysis either with a fistula or graft. Data were extracted from electronic and medical records which included information on demographic and dialysis treatment. We ascertained the hemodialysis patients and the death by validating our data with the Thailand Renal Replacement Therapy registry database and Civil registration database, respectively.  Patients were followed up until death or December 31, 2020.

               Total of 579 patients were analyzed; 505 (87.2%) and 74 (12.8%) patients underwent unplanned and planned hemodialysis, respectively. The mean age at dialysis initiation was 60.9± 0.6 years, and 51.5% were male. Most planned hemodialysis patients had Civil Servant Medical Benefit Scheme reimbursement (58.1%). The median survival time of unplanned and planned hemodialysis was 3.5 years and 5.3 years, respectively. Survival rates at 1 and 5 years were 72.3% vs. 83.3% and 37.9% vs 55.0% for unplanned vs. planned hemodialysis, respectively (p = 0.031). On univariate analysis, age, diabetes, cardiovascular disease, and unplanned hemodialysis were significantly related to death. On multivariate analysis, age, diabetes and unplanned hemodialysis remained significant with adjusted hazard ratio of 1.03 (95%CI, 1.02-1.04; p <0.001), 1.34 (95%CI, 1.04-1.72; p = 0.022) and 1.49 (95%CI, 1.04-2.12; p = 0.029), respectively

               Unplanned hemodialysis initiation was common among CKD patients and associated with poor survival. The factors associated with mortality were age, diabetes, and unplanned hemodialysis.